title: [Home care and place of death for elderly people living in the remote islands of Japan. An examination on the presence of inpatient facilities].
abstract: OBJECTIVE
  The purpose of this study was to clarify the actual status of end-of-life care for elderly people living in the remote islands of Japan, and whether the presence of inpatient facilities was related to the place of death, so as to obtain suggestions for constructing a system of end-of-life care.
  
  
  METHODS
  The survey targeted caregivers (85 people) who cared for elderly people (aged 65 and over), who had been legally certified for long-term care, and who had died between April 2009 and July 2011 in five islands of Japan. Islands were selected from a list of remote islands specified in the Remote Islands Development Act and related laws. Using a mixed method embedded design, we conducted semi-structured interviews using a questionnaire that assessed the place and cause of the elderly patient's death, age at death, gender, and whether the patient or family members had requested that the patient be allowed to die at home.
  
  
  RESULTS
  The proportion of elderly people who died at home in the group living on remote islands with no inpatient facilities was 39.0% (16 of 41 people), compared with 18.2% (8 of 44 people) living on islands with inpatient facilities. The difference was significant (P=0.029). Among the 24 elderly people who died at home, 6 died of cancer. Terminally ill cancer patients were released to die at home under three conditions: the caregivers could provide sufficient care, the visiting physician was present, and pain control was provided. It was also possible for elderly cancer patients to receive end-of-life care in remote islands that did not have inpatient facilities. In addition, among the elderly people who died at home in the remote islands, home care had been recommended by medical staff.
  
  
  CONCLUSIONS
  It is important for professionals coordinating home care to understand the characteristics of diseases, perform early assessment of caregiver situations, and collaborate with medical staff.
authors.affiliation: Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo.
authors.forename: Naoko
authors.initials: N
authors.lastname: Horikoshi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kuwahara
authors.forename: Atsuko
authors.initials: A
authors.lastname: Taguchi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nagata
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Murashima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006699:Home Care Services / Q000600:supply & distribution; D006707:Homes for the Aged / Q000600:supply & distribution; D006801:Humans; D007407:Interviews as Topic; D007564:Japan; D008297:Male; D008507:Medically Underserved Area; D013727:Terminal Care / Q000592:standards*